Introducing a human rights-based approach to HIV in the Middle East and North Africa (MENA) Region: A mixed methods study.

The Middle East and North Africa (MENA) region is one of the few areas experiencing an increase in HIV prevalence, attributed to insufficient political commitment, stigma, and the criminalization of key populations (KPs). This study provides a human rights-based analysis of the experiences of KPs and individuals living with HIV (PLHIV). Using a convergent mixed-methods design, data were collected through an online survey (N=100) and qualitative interviews/focus groups (N=38) across Arabic-speaking MENA. Findings indicate that participants perceive their socio-legal environments as hostile, leading them to prioritize structural challenges and survival strategies over access to HIV services. The most significant challenges identified include social and familial violence (N=66), criminalization (N=57), and poverty (N=56), while access to HIV medical services was ranked as the least pressing concern (N=26). The primary advocacy priority identified was 'law and policy reform' (N=60), with the most sought-after services being 'pro bono legal aid' (N=37) and 'mental health support' (N=34). This research highlights a disconnect between community realities and the prevailing medicalized response to HIV, emphasizing the need for funders and policymakers to reorient strategies from a narrow service delivery model to a comprehensive human rights framework that prioritizes legal reform and holistic security.